State Medicaid reform: 'Rubik's Cube'

State Sen. Roger Reitz squared off Monday with Lt. Gov. Jeff Colyer about prospects for significantly curtailing the cost of Medicaid services without undercutting quality of patient care.

"I don't see how it can possibly work," said Reitz, a Manhattan physician. "You're going to have people marching on the Statehouse."

Colyer, a surgeon and chairman of Gov. Sam Brownback's task force on  reform of Medicaid, said he couldn't concur with the senator's diagnosis.

"I respectfully disagree," Colyer said.

"I'm sure you do," Reitz replied. "You're never going to cut medical costs down. You know that."

So it went during a back-and-forth hearing conducted by the House-Senate Health Policy Oversight Committee into preliminary findings of the executive branch's research on overhaul of the health program for low-income Kansans. The objective is to guarantee a safety net for patients and diminish costs to taxpayers.

Colyer said rising expenditures — a projected 400 percent from 2000 to 2019 — placed an unsustainable burden on Kansas government. He stopped short of unveiling  Brownback's preferences for reform, but summarized ideas likely to be in the mix during the 2012 legislative session.

It would be impossible to overstate the complexity of reshaping a program involving vulnerable patients and medical providers, as well as state and federal governments, he said.

"This is the ultimate Rubik's Cube," said Colyer, referring to the world-famous toy.

The lieutenant governor said there was no realistic way to avoid budget reductions in Medicaid, but he declined to comment on speculation by Rep. Jim Ward, D-Wichita, that the target ranged from $200 million to $400 million.

Colyer said the state likely would absorb hundreds of millions of dollars in federal aid cuts during the next few years.

"We are going to have to make some cuts," Colyer said. "Everybody is going to end up sharing."

He said critics of Medicaid spending reductions should consider an alternative centering on deeper reductions to K-12 and university education.

The Brownback administration is committed to creation of a financially sustainable Medicaid program that involves "high-quality, holistic care and promotes personal responsibility," Colyer said.

Colyer said he would prefer to avoid cutting people out of Medicaid. Missouri, for example, trimmed 100,000 from its list.

Other options include reductions in medical provider rates and conversion to a managed-care model that assigns coordinators to care for patients with the most complicated medical conditions. Targeting the most complex medical cases makes sense, he said.

"Twenty percent of the Medicaid population consumes 80 percent of the resources," Colyer said.

Obtaining a policy waiver from the federal government, which jointly finances Medicaid, would allow Kansas to implement unorthodox reforms, Colyer said.

The Medicaid system is plagued by mountains of paperwork that would benefit from greater reliance on computerized health records, Colyer said. Strategies to delay or prevent people from entering nursing homes should be a priority, he said.

"Our goal," he said, "is to save money by getting better results and avoiding institutionalization."

He said patients should be offered incentives to stop smoking or diet effectively to counter obesity. At the same time, he said, the Kansas could leverage state programs to help people with disabilities obtain jobs and private health insurance.

YouTube videos a profitable sideline for Temple student

Charming in a goofy way, Rob Homayoon, a 25-year-old dental student at Temple, has found a way to make money for himself by creating origami paper cranes and solving Rubik's Cube on YouTube.

"Hey, hey, what's going on," Homayoon begins, making a silly face in one of his most recent videos on YouTube, the Google-owned website that collects videos posted by individuals and companies.

"I made it a little bit easier for those of you who think you're funny and post your little comments below saying, 'Oh My God, pause at zero colon zero three, his face is sooo funny.'

"Just remember, you can't pause real life," he said.

But we can pause right here to let you know how Homayoon is making his money ($70,000 since 2008) and why.

YouTube's publicists are touting Homayoon as a success story in their partnership program, which could also be titled "Feeding the Beast," although YouTube doesn't call it that.

Kate Rose, a YouTube spokeswoman, explains: YouTube gets two billion video views a day, or 14 billion a week. Meanwhile, it has managed to monetize three billion video views a week and would love to monetize more.

Monetize is the magic word, meaning YouTube has been able to attract companies to pay to place their advertisements on various videos. Advertisers like good content, especially when it comes with a reliable and large audience.

The bigger and more reliable the audience, the more they are willing to pay in a process that works like an auction, as advertisers bid up for the best spots.

That's where Homayoon comes in.

His early videos on solving Rubik's Cube attracted enough of a following that he set up his own channel, "Rob's World."

As his audience grew, he applied to become a YouTube partner. He qualified because he had built an audience by producing his own top-quality videos using his own material. YouTube doesn't get much more specific about its partner threshold.

As of Friday morning, Rob's World had 24.9 million uploads and 64,525 subscribers wanting to be notified every time Homayoon posts a new video. That's quantity and reliability.

"Millions of viewers translates to thousands of dollars" for the video's creators, said Annie Baxter, another YouTube spokeswoman. "That's a rough guide."

The more the advertisers pay, the more both Homayoon and YouTube earn. YouTube wouldn't discuss the arrangement, but Homayoon said it was an 80-20 revenue split, with Homayoon getting the 80 percent share.

The money works as an incentive to keep creative people such as Homayoon producing quality videos "and to actually treat it like a job," Baxter said.

"The more people who treat it like a job and produce quality videos, the more people who will come back to YouTube," she said. "That's going to grow more quality programming to run advertising against."

Homayoon works to build views. His most successful video, now a year old, was an eight-minute, 37-second tutorial on making origami paper cranes. Now he's back with a new video that promotes making paper cranes as a way to raise money for tsunami victims in Japan.

Everything on his channel links to everything else, so every click around the channel adds to his statistics, making him more valuable. He constantly invites comments and responds to them, building his community - and his viewership.

The videos are shot in his apartment, nothing very elegant - a few bookshelves in the background. "I'm showing that I'm in my apartment and that I'm doing it all by myself," said Homayoon, who lives in Germantown.

"It is really hard to balance my life, school, and YouTube," he said. "This could be a full-time job, if I really wanted it to be."

His subscribers, he said, hound him if he doesn't produce. They comment, "When is your next video? Are you dead?"

"They get pretty funny on the comments," Homayoon said. "They want to know there is a person behind the video."

At first, he kept it simple, just posting whatever he could create in a few hours. But now, he said, it takes him days to produce a video and he has invested in a better camera. (Just the type of behavior YouTube wants.)

"When I first started, I got $100," he said, "and I thought, 'I can pay for my gas with this. I can go out to dinner.' Then it went up to $400 or $600 and eventually, I started into $1,000, then $2,000.